What is
The Mislabeled Child
The Mislabeled Child
Looking Beyond Behavior to Find
the True Sources—and Solutions—for
Children’s Learning Challenges.
Brock Eide M.D. M.A. and Fernette Eide M.D.
MislabeledChild.com
The Status Quo:
Too Often, Labels are
“Merely Mirrors”
When children struggle, the labels they are given often
simply hold up a mirror to their problems:
• Trouble learning: “Learning Disability”
• Trouble paying attention: “Attention Deficit”
• Writing difficulties: “Disorder of written expression”
• Oppositional behavior: “ODD”
Michael
• 11 y.o. boy from a small Midwestern town.
• Very bright, but had surprising difficulty early
in school learning to read.
• Easily mastered letter names and sounds, but
struggled with decoding.
• In second grade, something “clicked” and silent
reading comprehension skyrocketed.
• In third grade, top reading group in class, and
consistently scored in 90%ile in reading
comprehension tests.
• So, where’s the problem…?
About?
• Learning Differences and Learning Styles: How children
(and their brains) learn, and how different children learn
and process information differently.
• Specific Learning Challenges: Why children struggle, and
how to help them when they do.
• The many reasons for Hope and Optimism that exist
when children struggle, due to the incredible and
often untapped learning resources of the brain.
True Sources Often Lie Deeper…
Failure to delve more deeply—
beyond behavior—for the true
sources of a child’s struggles
can result in misdiagnosis,
mislabeling, and mistreatment.
As was the case for Michael…
Michael
Despite strong comprehension of longer passages,
Michael showed:
• Poor word-by-word decoding.
• Impaired oral reading.
• Difficulty reading short succinct sentences like story
problems in math or instructions on tests.
• Severe difficulties with spelling.
• Incredible difficulties with handwriting.
• “Careless mistakes” in math.
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Michael Michael
Even writing the alphabet was difficult:
Written
copy

Free
writing

Notice his problems forming cursive f, k, o, q. Notice the problems with margins, spacing, spelling, consistent
On printing, notice awkward forms like a, k, m, n, q, u; the letter formation, and the use of conventions like capitals and
wandering line; and g substitution for j. periods.
When writing whole sentences, the problem got worse… Some problems persisted even with keyboarding…

Michael
Michael
A post-it note
Story in the 5th Grade, A
Michael
post-it
mostattached
Michael of
placed
note
the it
to one of his
by keyboard: spelling pre-tests
where he missed
Kick me nearly all of the
“On a planet farfay awaw There was a items.
youno man by the name of uragoner who
set of for the edges of his planet in surch of
the plantes bengines. His cutter had mot
alwalec peen on This planet.”
• By fifth grade, Michael’s ability to cope was exhausted.
• He repeatedly called self stupid and dumb, and began
Instead of reflecting his interesting, intelligent, and often humorous hitting himself on his head, saying he deserved to be
thoughts, Michael’s writing was much poorer in form and content punished for being so stupid.
than his speech, which made him embarrassed and self-critical…

Michael
In Reality: Energetic, Painstaking, and REALLY SMART
Michael
VIQ 137 PIQ 119
The school proposed a
Vocab 17 Obj As 14
number of explanations for Comp 17 Pc Com 13
Michael’s difficulties: Simil 16 Pc Arr 13
a) Inattentive and careless, Arith 16 BD 13
Infor 15 Cod 11
b) Not trying hard enough, or Dig Sp 15 SS 11
c) Unrealistic expectations: too smart to have a disability,
but not smart enough to do any better.

Their bottom line: Because Michael wasn’t actually

Rokenbok
failing, he didn’t qualify for special help. Goal in Life: Engineer

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 Stealth Challenges: Michael
“The Beginning of Wisdom
Is Calling Things
By Their Right Name”:
-- Ancient Chinese Proverb

• In Michael’s case, the struggle was with what we call

Michael is a perfect example of why the
kinds of labels we apply to children
matter, and of the truth of the
statement with which we open our
book.
“stealth dyslexia.”
• Michael was a perfect example of a child with “stealth
challenges”—or problems that evade the usual “radar of
detection.”
Michael needed help with the way his brain processed sound,
visual, and sensorimotor information, and he needed to learn
how to use his many strengths to overcome his weaknesses.

The Mislabeled Child Partial Pictures

Michael shows how learning challenges aren’t just issues

for children formally identified as needing special
services, but are often present in children who aren’t
identified as having specific learning challenges, yet
show:
• Underachievement relative to intelligence
• Inattention or apparent carelessness
• Disorganization
• Overloading, anxiety, or depression In some cases, their weaknesses may be identified but
• Social or behavioral difficulties their strengths missed, resulting in labels that tell only
part of their story.
Such children are often mislabeled…

Look Alikes Look Alikes: Ethan

• Bright, energetic 9-year-old boy.

In other cases their behaviors may meet criteria for a
commonly used diagnostic label (often from the DSM-
IV), but may actually be caused by other
unrecognized—and treatable—issues that affect
learning and information processing.
As happened with Ethan…
• Intense, active, emotionally and physically sensitive.
• Highly self-directed in activities, difficulty with
transitions and unexpected changes.
• Difficulty conforming to classroom demands.
• Socially, interacted well one-on-one with older
children, but few friends among age peers.
• Poor eye contact, missed social cues, overloads in
large groups.

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 Look Alikes:
Ethan
University Clinic diagnosed him (Sort of) with:
• “Probable ADHD"
• “Possible Anxiety Disorder"
• “Cannot rule out Asperger's syndrome" and
• “Motor Coordination Difficulties reported with
reported dysgraphia [i.e., severe handwriting
problem]."
What We Found
With Ethan
• Severe handwriting impairment, source of much
anxiety and misbehavior (improved with specific
instruction, strengthening, and accommodations).
• Sensory-seeking (movement and touch/pressure)
behaviors (improved with sensory input and
movement breaks).
• Sensory-based social difficulties (improved by
practice with verbal conflict resolution and social
problem-solving scenarios).
How to Avoid and Mishandling
Two steps to go beyond behaviors or isolated scores to
truly understand a child’s learning challenges and to
give that child what he or she needs.
Of Children
and Checklists
• The tentative nature of these diagnoses reflects the
recognition by these professionals that labels like ADHD
or Asperger syndrome couldn’t capture Ethan’s full
complexity.
• Behavioral checklists often miss the fact that similar
behaviors can have vastly different causes, and require
vastly different solutions.
• In the MLC, we try to describe and deal with that
richness and complexity, but in a way that makes it easy
to understand and address.
Notice…
It was only by looking beyond Ethan’s behaviors
to find their causes in his problems taking in,
processing, and expressing information, that we
were able to match those problems with
appropriate solutions.
Step 1: Create a Complete
Learning Profile
Create a complete learning profile of a child’s strengths,
weaknesses, interests, temperament, and learning
style.
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Step 1: Create a Complete Step 2: Optimize Education
Learning Profile
In particular, systematically identify strengths
and weaknesses in:
• Information Input
• Pattern Processing
• Output for Action Optimize education and environment by designing a
detailed plan of learning, therapy, and play, that
• Attention improves areas of weakness, relies more heavily on
In other words, the underlying factors that can present areas of strength, and provides accommodations that
as difficulties with academic and behavioral function. get around unnecessary difficulties.

Step 2:
Optimize Education
In MLC we describe in detail how to make such plans It all begins with…
to help with challenges in specific academic areas like:
• Reading and spelling;
Assessment
• Handwriting and Written Expression;
• Math.
As well as more general challenges in:
• Memory and imagery; Key Point:
• Visual or Auditory processing;
• Sensorimotor function; • Behaviors are useful starting points but insufficient
• Language; for diagnosis.
• Attention; • Similar behaviors can have very different causes.
• Autism;
• Intellectual Giftedness.

Aspect 1: Information Input

Going to the Source:
Aspects of Brain-Based Learning
Eyes
Ears

1. Information Input
2. Pattern Processing
Main Routes for
Attention
3. Output for Action Information Input
4. Attention Touch / Movement

• Input Problems Affect Downstream Functions

and Development (Garbage In, Garbage Out)

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 Information Input: Micah
Information Input:
Micah
• 6-year-old boy, worsening self-esteem, school phobia 2 minute copy: “While Ben was…” Exact figure copy
and refusal, behavioral problems.
• In kindergarten oral language tested at 99%ile.
• In first grade, trouble learning to read and write.
• Sloppy work, incomplete math work, poor visual Circle “bund”
memory, learns better one-on-one.
• Increasingly anxious, aggressive, and hyperactive in • On our testing, Micah extremely intelligent and polite—
class. His teacher suspected ADHD and ODD. until testing stressed his vision.

Information Input:
Information Input:
Micah Couldn’t See
Brain Can’t See Auditory – Unrecognized Ear or Brain-Based
Before
Hearing Problems (“Brain Can’t Hear”)
Non-Dyslexic Touch / Movement – Sensory Processing Problems
or Mild Auditory + Visual Problems

Dyslexic Brain-Based Problems of Information Input are Often Missed

9 months later
Glasses + Therapy.
Improved Visual Memory,
Problem-solving, Not Hearing
and Behavior. Rhymes in Dyslexia
Non-Dyslexic Dyslexic

Flash from the Past Weak Vision, Strong Visual Imagery

Immature Auguste Rodin
“…he was quieter and more thoughtful: while the others played games,
he would stay close to his mother…”
Different Sculptor – Severe Myopia – Spatial Genius
Play In His Head

“…neither the school nor the curriculum had appealed to him…he had
spent most of his time ‘drawing fanciful designs, telling stories, and
reciting imaginary descriptions to his comrades…”

“His hands were never still. He was always manipulating pieces

of clay with his fingers…” Odd Habits Fidgety

Hidden Disability
“I hated mathematics because I could not see.”
Other Senses May Become Stronger

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 Pattern Processing
Aspect 2: People Often Differ Dramatically in their
Preferred Types of Memory
Pattern Processing

• How We Recognize, Remember, and Organize

Information.
- Memory Systems (File Cabinets)
- Imagery Systems
- Pattern Association
• Helps us understand, predict, and plan.
Dramatic Effect on Learning Efficiency Permanent Learning

Pattern Processing: Pattern Processing: Kendra

Kendra, The Forgetful Learner
We Found:

• Kendra was 7, beloved by teachers and students
• Polite and Attentive, but very Forgetful!
• Kendra’s parents told us, “She remembers some things
very well, but other things she has to learn again and
again…”
• Struggle to Remember 3 Numbers in Correct Sequence
• Instruction to “Visualize”: Still Can’t.
How Did She See Them?:
“Glittering numbers dancing across a stage.”
• Then: “Keep the numbers on the stage after they dance.”

Kendra now remembered 5! —Great Performance for Age.

Natural Storyteller Playground Stories Birthday Party
Can’t Remember What Learns at School Strategic Memory Imagery Personal Learner

Flash from the Past Enrico Fermi

• Poor memory • Nobel Prize winner in physics

• Split the atom
• Called his notebook his “artificial memory” • Famous as a teacher – trained 4 Nobel
prize winners
• Couldn’t take notes because he said it was too • Always gave lecture handouts when
teaching because he had struggled with
hard to listen and write at the same time
note-taking himself…

• Needed more time to ruminate over new concepts

You can be smart and have a poor working memory
Success or Failure Depending on How Information Presented
Uni-tasker Slow thinker Spatial & Conceptual Strengths

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 Aspect 3: Output for Action:
Output for Action Ben

• Happy, outgoing, and well-behaved in kindergarten.

• Goal of learning not just understanding, but action.
• Output may involve oral or written language
expression, handwriting, taking notes, acting in
response to directions, or other large or fine bodily
actions… potential “Explosive Child”
• Great reader, strong speller, terrific language skills.
• As first grade progressed, mood and behavior
deteriorated: angry, oppositional, work refusal, lying to
parents about homework.
• Cause: Ben had severe difficulties with handwriting.

Output for Action: Ben Dysfunctional Grips Accompany

(Dysgraphia/Handwriting Impairment) Many Forms of Dysgraphia

7 y.o.: “ In 1909 he painted ‘Bread and Fruit Dish on Table.’ This was Important: Abnormal Grip A Sign of Deeper Problem:
the beginning of the period known as Cubism. Cubism splits forms
into facet-like shapes.” Tearing up own work in art class
Not Itself the Cause of Handwriting Impairments!

Output for Action —Ben

Flash from the Past
Writing Accommodations
Dictation & Keyboarding
Therapy to Strengthen “He could never use a dictionary, couldn’t keep
More Time track of time, struggled with a lisp, and preferred
from his adolescent years to dictate rather than
Before OT to write…”

After OT

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 Aspect 4:
Attention
Key Points:
Not a Single Function!
Winston Churchill
Not a Single Solution!

• Spotlight : Direction, Strength, Persistence of Focus

It’s possible to be a great orator and win a Nobel
Prize in Literature, but struggled with speaking and
writing as a child…
• Juggler (Working Memory) : Information at Once
• Creative Corporation (Organization and Creativity)
• Different Modes of Attention – Seeing, Hearing, or
Doing…
• Intervention must match deficit.

Music and Visual Power of Language Talented Painter Statesman

Long Preparation Time for Speeches

Inattention Due To Visual Distractibility Attention and Development

Auditory and Visual Attention Improve with Time

• Difficulty persisting with reading or worksheets due to visual

Age
crowding and distractibility.
• “I can do 40 problems if there are 4 on each page, but
I can’t do 4 if there are 40 on a page.” Visual Coordination Boys Poorer Auditory Attention in Elementary School
• Frequent source of “careless mistakes.” Brain-Based Visual Issues Behavioral Checklists Don’t Consider Developmental or Gender Differences
Visual Crowding is Real!

The Executive “Corporation”

Training Creativity & Operations
(Gifted Children Mislabeled with ADD) Pitfalls of Chief Operation Officers

Chief Creativity Officer – Right Brain

• Combines Ideas, Sensations, Images • “Oh no, I have to think?”
• Generates Alternative Approaches • Fails to Consider Alternatives
• Expands Possibilities and Associations • Misses the Forest for the Trees
• Prefers ‘The Big Picture’ • Derivative More Than Innovative

Chief Operations Officer – Left Brain “Valedictorians tend to be very conscientious, responsible
• Oriented to the ‘Bottom Line’ people who achieve a type of well-rounded success...but
• Focusing & Prioritizing Goals what they don’t have is that overriding passion for a single
• Deals with Detailed Planning and Implementation thing that is often what makes you eminent in later life...”
Rypma, Rutgers Karen Arnold, Ph.D.
Illinois Valedictorian Study

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 Successful Problem Solving Requires
Cooperation Between the Right & the Left
Pitfalls of Creativity Directors
Tower of London

• Disorganization
• No Priority, No Plan
• Unfinished Work
• Poor Verbal Communication

Choice Possibilities
Just, Carnegie Mellon

Some Gifted Differences

Rooted in Brain Biology Development May Differ in Different Areas:
The Higher the IQ, the More Delayed
Executive Function (Prefrontal) Maturation Unevenness is More Common with Higher IQ

Then Thicker Brain

Young Gifted Cortices in the Teen WISC-III VIQ / PIQ Discrepancies – 18 Points or More
Children Have Years
Thinner Cortices Control Sample 17.0 %
Before the Age of 10 Gifted Sample 54.7 %

Delays may be especially pronounced for children with Sweetland, Port Washington School District
sensory processing and motor coordination deficits.

The Gifted-Backward Paradox

“My teachers saw me at once backward and precocious, reading books
beyond my years and yet at the bottom of the Form. They were offended.
They had large resources of compulsion at their disposal, but I was
stubborn.” Winston Churchill
“The servants all thought that young Isaac was foolish,
and his mother did not know what to do with him…”
From Isaac Newton, The Greatest Scientist of All Time
The Teaching Paradox –
More Learning with Greater Challenge
My chief deficiency was arithmetic. Here my understanding was far beyond my
manipulation, which was definitely poor. My father saw quite correctly that one
of my chief difficulties was that manipulative drill bored me. He decided to take
me out of school and put me on algebra instead of arithmetic, with the purpose
of offering a greater challenge and stimulus to my imagination.
Norbert Wiener, Nobel Laureate in Physics

“I used to take these maths tests which were supposed to be done

in one period and it took me not just that period but the next one
which was a play period and sometimes the one beyond that…”
Roger Penrose, Cambridge Math Professor

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 Downside: Disorganization Inattention: Creativity Officer on Steroids
The Highly Active Mind
Is Often…Distracted and Disorganized
“Constantly late for school, losing his books, and papers and
various other things into which I need not enter– he is so regular in
his irregularity in every way that I don’t know what to do.”

--Winston Churchill’s Principal

"It looks like she's doing the dishes but she accidentally left it on.
When she went to get her apron, the kids were getting cookies
and the stool tipped over and the little boy's falling and some of
Einstein’s Office
the dishes were done but not all of them. and some of the water
was coming out and the curtains and the window were open and
some of the water got out. The girl was saying Mom!! The little
boy was falling. The mom said "I'll be there in a second--get out
of that cookie jar!"
7 y.o. gifted girl considered for attention problems

Who was this? Ansel Adams

Intense

“He was often ill, prone to fits of uncontrollable

weeping, and filled with a restless surging
energy he could not contain. He was enrolled without
success in one school after another and often
found it difficult even to remain seated at his desk...”
School Failure
Hyperactive
“I wanted to run down to the beach in sun, rain,
or fog and expend the pent-up physical energy
that simply fermented within me. Today I would
be labeled hyperactive.”
“I often wonder at the strength and courage my father had in
taking me out of the traditional school situation and providing
me with these extraordinary learning experiences. I am certain
he established the positive direction of my life that otherwise,
given my native hyperactivity, could have been confused and
catastrophic. I trace who I am and the direction of my development
to those years of growing up in our house on the dunes, propelled
especially by an internal spark tenderly kept alive and glowing by
my father.”
Optimism Non-traditional Schooling Personal Strengths

A Final Point on The Right Accommodations

Get Kids Into Learning,
“Helping Hands” for Kids Not Out Of It!

• Accommodations are ways to

improve function and increase
achievement, not to avoid it!

• Accommodations can be
enabling and therapeutic!
The Truth About Accommodations…

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 Author of “Mongl Invashon” after 2
years of “Write Outloud”
Gifted Dyslexic Boy

Before Using
“Write Outloud”
Software

"I am a Typhoon and I am on my way to Japan and gathering

spead. I mite be the Typhoon that destrois the mongls and their
ships on their second invashon of Japan.... My stronggest power
is wind wich can make trumendus waves that can capsise the
With Constant Feedback, Student Internalized Spelling Patterns
stronggest mongl ship."

The Mislabeled Child

Take Home Message:
Focus on Learning Abilities

Brock Eide M.D. M.A. and Fernette Eide M.D.

• Behaviors are just starting points: Appropriate labeling--and
intervention—requires going Beyond Behavior.
• The Brain is remarkably “Resource-Full”
• Looking carefully at each child will reveal the
hidden depths of their true learning potential.
Brock Eide M.D. M.A. and Fernette Eide M.D.
MislabeledChild.com
MislabeledChild.com
“The Mislabeled Child represents a significant step toward a
rethinking of our understanding of struggling children. It…will
enable us to customize education and parenting for children
whose minds work differently from most!”
--Mel D. Levine, M.D., Author A Mind at a Time

“Partial Pictures”: Marshall “Partial Pictures”:

• Quiet 6-year-old, struggled in all subjects in school.
• Built complicated Lego and Knex structures.
• Drew beautifully detailed animals and insects, and
loved picture books.
• At school he just looked lost.
• School psychologist decided “borderline mentally
retarded.”
• Family thought otherwise. They’d seen this story
before.
Marshall
• Marshall’s father now a highly successful business
owner with dozens of employees.
• At age 8, nearly mute, institutionalization considered.
• Parents suspected hearing problems, and spent hours
barraging him with oral language.
• By fourth grade: reading. By eighth grade: grade
level in all subjects. By high school: honor roll.

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 “Partial Pictures”: Why
Marshall Mislabeling
We Found:
Matters
• Confused unless we showed him rather than told him
what we wanted him to do. • Labels may put a name to a child’s problems—often by
• Strong ability in spatial and mechanical reasoning. simply describing or restating behaviors—yet fail to
determine why those behaviors occur.
• Severe, heritable—but potentially trainable--difficulty
hearing the different sounds that make up spoken • Such inappropriate or incomplete labeling often
words. prevents students from receiving the help they need to
find success.
• Common patterns of mislabeling:
* Stealth Challenges * Look-Alikes * Partial Pictures

Another Key Point…

Like Many Brain-Based Learning Challenges,
Brain-Based Hearing Problems Are Subtle And Often Missed:
Like the boy who told us, “It’s hard for me to spell “World”
because the “r” is silent.”

Missed learning challenges lead to:

• misdiagnosis,
• mislabeling, and
• mishandling.

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